Knowledge does not predict prevention: A cross-sectional analysis of the caregiver knowledge–practice gap for childhood intestinal parasitic infection in rural Rwanda

Resumo

This study examined awareness, knowledge, and prevention practices related to childhood parasitic infection among female carers of children under five in rural southern Rwanda and assessed whether knowledge predicted prevention after adjustment for socio-demographic and access-related factors. This article reports the quantitative component of a sequential explanatory mixed-methods study conducted in four rural districts of Southern Province, Rwanda. One health approach was used as an aspect of the theoretical framework to guide the study. The target population was found in four districts of the southern province, corresponding to 3.2 million, which involved carers and community health workers. The study involved 407 respondents. Data were collected using a structured questionnaire, a semi-structured interview guide and a household observation checklist. Descriptive statistics summarised awareness, knowledge, care-seeking, and prevention practices. Chi-square tests assessed bivariate associations. Logistic regression, robust ordinary least squares regression, and Firth logistic regression were used to model awareness, adequate knowledge, prevention practices score, good prevention practice, and missed appointments due to transport. The findings indicated that awareness of intestinal parasitic infection was high (94.35%), but the mean knowledge score was only 3.17 out of 10 (SD 1.95). The mean prevention practices score was 4.07 out of 10 (SD 1.32), and only 3.19% of carers met the threshold for good prevention practice. Education was the strongest and most consistent predictor of both knowledge and prevention. In contrast, the knowledge score was not significantly associated with either the continuous prevention practices score (β 0.00, 95% CI -0.08 to 0.08; p = 0.986) or the binary good-practice outcome. Safe water storage, water treatment, frequent handwashing, and toilet cleaning were uncommon. More than one third of carers reported having missed appointments because of transport barriers. The study concludes that awareness was high but not associated with prevention; education was the strongest predictor of the household practice. The study recommends that strategies to reduce childhood parasitic infections in rural Rwanda should move beyond awareness campaigns and prioritise practical behaviour support, household-level WASH-enabling conditions, and interventions that reduce access barriers.